Provider Demographics
NPI:1841772035
Name:LOCUST DENTAL GROUP JEFFREY S ROSENTHAL DDS INC
Entity Type:Organization
Organization Name:LOCUST DENTAL GROUP JEFFREY S ROSENTHAL DDS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHREVES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-352-5700
Mailing Address - Street 1:300 LOCUST ST STE 430
Mailing Address - Street 2:
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44302-1804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:300 LOCUST ST STE 430
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44302-1804
Practice Address - Country:US
Practice Address - Phone:330-535-7876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-04
Last Update Date:2018-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental